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*OldPharm > Adrenal > Flashcards

Adrenal Flashcards

1
Q

what are 2 conditions w/ hyperfunction of the adrenal gland

A

Cushing’s syndrome

Hyperaldosteronism

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2
Q

what are conditions that lead to Hypofunction of the adrenal gland

A

Primary adrenal insufficiency- Addison’s Disease

Secondary adrenal insufficiency

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3
Q

what Stimulates the release of adrenocorticotropic hormone (ACTH) from the anterior pituitary

A

Hypothalamus releases corticotropin-releasing horming (CRH

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4
Q

ACTH stimulates the adrenal gland to release

A

cortisol

Also releases aldosterone and androgens

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5
Q

in response to ↓ blood pressure, salt depletion, CNS excitation what is released from the kidney

A

renin

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6
Q

what condition leads to ↑adrenal function =↑cortisol production

A

cushing’s syndrome

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7
Q

what are ACTH-dependent cushing’s syndrome

A

Pituitary tumor: excess ACTH secretion
Stimulates adrenal glands to secrete excess cortisol
Ectopic disease: ACTH secretion from another tumor

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8
Q

What are ACTH independent cushing’s syndromes

A

Adrenal adenoma: benign
Adrenal carcinoma
Exogenous Steroids

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9
Q

S/S of cushing’s

A 
central obesity
purple striae along lower abdomen
moon face
supraclavicular fat pads
buffalo hump (fat in the dorsocervical area) 
HTN
glucose intolerance
muscle weakness 
osteoporosis
gonadal dysfunction (amenorrhea)
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10
Q

how to confirm cushing’s disease?

A

Elevated urinary free cortisol- confirms hypercortisolism

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11
Q

to determine the cause of cushing’s what should you get?

A

plasma ACTH

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12
Q

what is the treatment of choice for tumor w/ cushing’s

A

surgery

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13
Q

what is used for non-surgical canidates w/ cushing’s due to a tumor

A

Steroidogenic Inhibitors

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14
Q

what are Steroidogenic Inhibitors

A

metyrapone

Aminoglutethimide

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15
Q

what will initially occur w/ metyrapone

A

increase in plasma ACTH are first then will stop

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16
Q

ADRs of metyrapone

A

alopecia
hirsuitism
HTN
N/V

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17
Q

inhibits conversion of cholesterol to pregnenolone in adrenal glands
Blocks conversion of androstenedione to estrone and estradiol in the peripheral tissues
used for ectopic ACTH

A

Aminoglutethimide (Cytadren®)

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18
Q

ADRs of Aminoglutethimide (Cytadren®)

A

N/V
sedation
hypothyroidism (blocks synthesis of thyroxine)

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19
Q

antifungal agent that also inhibits synthesis of androstenidone. used for adrenal adenoma

A

keotconazole

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20
Q

adrs w/ ketoconazole

A

Hepatotoxicity
Monitor LFTs
Gynecomastia – decreased testosterone levels
Nausea

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21
Q

absorption of ketoconazole required what?

A

an acidic pH

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22
Q

what are adrenolytic agents

A

mitotane

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23
Q

cytotoxic drug that results in atrophy of the adrenal cells, also used for adrenal carcinoma

A

mitotane

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24
Q

what must you monitor w/ mitotane

A

urinary free cortisol

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25
Q

ADRs w/ mitotane

A

N/V – administer with food
Lethargy and somnolence
Hypercholesterolemia

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26
Q

with primary aldosteronism where is the problem

A

adrenal cortex due to aldoesterone producing adenoma of hyperlasia

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27
Q

results from stimulation of the zona glomerulosa by an extraadrenal factor (usually RAAS) but also due to excessive K+, pregnancy, CHF, cirrhosis, renal artery stenosis

A

secondary aldosteronism

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28
Q

how to differentiated primary and secondary aldosteronism

A

plasma-renin activity ratio

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29
Q

S/S of hyperaldosteronism

A 
Hypertension
Hypervolemia
Hypokalemia
Hypernatremia
Leads to fluid retention
Muscle weakness
Fatigue
Headache
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30
Q

if hyperaldosteronism isn’t due to a tumor of surgery isn’t an option what is the DOC?

A

spironolactone (aldosterone antagonist)

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31
Q

what to minotr w/ spirolonlactone

A

Blood pressure
Sodium and potassium
SCr

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32
Q

ADRs w/ wpironolactone

A

Hyperkalemia

Gynecomastia

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33
Q

an alternative aldoestonate antagonist for thsoe that can’t tolerate spironolactone ?

A

epleronone

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34
Q

what is due to destruction of the adrenal cortex. causes a deficiency in cortisol, aldosterone and androgens

A

primary addison’s

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35
Q

what causes secondary adrenal insufficiency?

A

suppression of HPA axis from exogenous steroid use

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36
Q

what is an ACTH deficiency

A

Deficiency in cortisol and androgens

Not mineralcorticoids

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37
Q

S/S and adrenal insufficiency

A 
weakness/ fatigue
anorexia
N/V abdominal pain
HPOTN
craving of salt
hyperpigmentation
muscle/joint symptoms
sexual dysfunction
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38
Q

labs findings w/ addison’s

A

Hyponatremia
Hyperkalemia
Hypercalcemia
Azotemia

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39
Q

diagnosis of adrenal insufficnecy

A 
cosyntropin stimulation (synthestic ACTH) 
if adrenal glands are functionign normally plasma cortisol levels should rise (rules out primary adrenal insufficiency cause)
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40
Q

tx for addison’s disease

A

glucocorticoid replacement

most of it given up in morning

41
Q

what is dosing compared back to w/ glucocorticoids

A

back to prednisone

42
Q

what do you need to monitor w/ glucocorticoids

A

monitor symptoms every 6-8 weeks look for glucocorticoid excess or lack of improvement and adjust dose appropriately

43
Q

what is a mineralcorticoid replacement? (only for primary)

A

fludrocortisone

44
Q

S/S of mineralcorticoid insufficiency

A

Hypotension
Hyponatremia
Hyperkalemia

45
Q

signs of excess mineralcorticoids

A

Hypertension
Edema
Hypokalemia

46
Q

what can cause secondary adrenal insufficiency

A

high dose glucocortidois for long term

after tx is stopped adrenals can’t generate enough cortisol

47
Q

what are S/S of glucocorticoid withdrawal

A

Malaise, myalgias, weakness, fatigue, anorexia

48
Q

what is an important risk factor for secondary adrenal insufficiency?

A

time- longer duration of therapy w/ glucocorticoids there is more risk

49
Q

ADRs of chronci glucocortidois

A

weight gain, increased appetitie
modd changes euphoria to depression
psychosis

50
Q

opthalmology problem w/ chronic glucocorticoids

A

cataracts when gluccocorticoids are used later in life

glaucoma (increase intraocular pressure)

51
Q

CV problems with chronic glucocorticoids

A

HTN

Dyslipidemia (increased TC, LDL, TG)

52
Q

Heme effects with chronic glucocorticoid use

A

Immunosuppression
Infection
Impaired wound healing

53
Q

GI ADRs w/ glucocorticoids

A

PUD (may occur more w/ NSAID use)

suppression of response to H. Pylori

54
Q

If a person is on glucocorticoids for >3 months what should you screen for?

A

osteoporosis- DEXA scan
do preventative bisphosphonate therapy plus calcium and vit d
aseptic necrosis hip, growth supression, myopathy

55
Q

Endocrine ADRS w/ glucocoritcoids

A

Cushing’s syndrome
adrenal suppression
glucose intolerance/ exacerbation of DM

56
Q

Visible ADRs w/ chronic glucocorticoids

A

Skin-Acne
Easy bruising- loss of collage support for BV
thin skin- atrophy
striae- atrophy of the SubQ tissue

57
Q

If a steroid is taken for longer than 1 week what should be done?

A

tapered down

58
Q

Education to give to patients on glucocorticoids

A 
take with food
never stop abruptly
wear a medial ID 
Ensure daily calcium intake is adequate
ADRs
59
Q

what can cause acute adrenal insufficiency (adrenal crisis)

A

trauma, surgery, illness, stress

60
Q

what are signs and symptoms of acute adrenal insufficiency?

A 
shock
coma
N/V
weakness
lethargy
61
Q

what do patients w/ adrenal insufficiency need?

A

stress doses of glucocorticoids

IV fluids, BP support

62
Q

what can be used to decrease potassium levels?

A

Fludrocortisone (mineracorticoid)

63
Q

what is an injectable glucocorticoid that a patient can use in an adrenal crisis?

A

Injectable hydrocotisone or dexamethasone

64
Q

what is released from the anterior pituitary

A 
GH (somatropin)
prolactin
ACTH
TSH
LH
FSH
65
Q

what hormones come from the posterior pituitary?

A

Oxytocin

Vasopresin (ADH)

66
Q

what is the excessive production of GH typically due to a GH secreting pituitary adenoma?

A

acromegaly

67
Q

how do you diagnose acromegaly

A

oral glucose tolerance test then do a
GH level >1mcg/L
elevated IGF-1 levels

68
Q

Tx for acromegaly

A

Surgery to remove the adenoma

69
Q

what are 3 pharm treatments for acromegaly

A

somatostatin analogs
dopamine agonists (decrease GH production)
GH receptor antagonist

70
Q

what is a somatostatin analgos? this is first line med therapy for acromegaly

A

Octreotide

71
Q

ADRs w/ Octeotide

A 
N/D
Hyperglycemia
Arrhythmias
Hypothyroidism
Cholelithias
72
Q

what are 2 dopmaine agonist?

A

bromocriptine

ergot alkaloid

73
Q

how long does it take for dopamien agonists to have a clinical response (have an immediate labl effect)

A

4-8 weeks

74
Q

ADRs w/ dopamine agonists

A

N/V
HA, dizziness
HPOTN

75
Q

what is a GH receptor antagonist. FDA approved for second tine therapy for acromegaly. Response seen in 2 weeks

A

Pegvisomat

76
Q

what must you monitor w/ Pegvisomat?

A

AST and ALT levels

77
Q

what is the most common presentation of GH deficiency?

A

short stature (>2 SD below population average)

78
Q

what is an acquired disorder that is similar to GH deficiency?

A

GH insufficiency

79
Q

First line tx for children for GH deficiency

A

recombinant GH

80
Q

other indications for GH

A 
turner's
prader-willi
children w/ chronic renal insufficiency
idiopathic short stature
adult GH deficiency (injury to pituitary) 
short-bowel syndrome
AIDS wasting syndrome
81
Q

what do all GH products contain? how are they given

A

somatropin

all given IM or SC

82
Q

how long does GH therapy continue for?

A

until growth velocity decreases to <2.5 /year after puberty

83
Q

ADRs w/ recombinant GH

A

Slipped capital femoral epiphysis

Idiopathic intracranial hypertension

84
Q

what is a recombinant insulin-like growth factor-1 (IGF_1) approved for children s/ short stature due to primary IGF-1 deficiency

A

mescasermin

85
Q

ADRS w/ mescasermin

A

hypoglycemia
dizziness
arthralgias

86
Q

what inhibits PRH signal?

A

dopamine

87
Q

Persistent prolactin levels > 20 mcg/L

Affects women of reproductive age

A

hyperprolactinemia

88
Q

10x the normal prolactin levels inhibit what?

A

gonadotropic secretion and sex-steroid synthesis
will go into a menopause state
increased risk for osteoporosis

89
Q

what can cause drugs induced hyperprolactinemia

A

DA Antagonists
prolactin stimulators
verapamil

90
Q

what are DA antagonists

A

Antipsychotics
Phenothiazines
Metoclopramide

91
Q

what are prolactin stimulators

A 
Methyldopa
Reserpine
SSRIs
Estrogens/Progestins
Protease inhibitors
Benzodiazepines
TCAs
MAO-I
H2-receptor antagonists
Opioids
92
Q

S/S of hyperprolactinemia in women

A 
Anovulation
Oligomenorrhea or ameorrhea
Infertility
Galactorrhea
Decreased libido
Hirsutism
Acne
93
Q

S/S of hyperprolactinemia in male patients

A 
Erectile dysfunction
Infertility
Decreased muscle mass
Galactorrhea
Gynecomastia
94
Q

Tx for hyperprolactinemia

A

bromocriptine- stimulates dopamine receptors

cabergoline- long acting dopaming agonist

95
Q

Tx of infertility due to hyperprolactinemia

A

Use barrier contraceptive method until prolactin levels are normalized
Reduce dose to minimum therapeutic dose before attempting to become pregnant

96
Q

what is the first line of tx for prolactinomas

A

cabergoline (better efficacy than bromocriptine)

97
Q

ADRs of cabergoline

A

valvular heart dz when used in high doses for long term

98
Q

monitoring for hyperprolactinemia

A

serum prolactin q3-4 weeks after drug initiation

once serum levels normalized monitor every 6-12 months

*OldPharm (12 decks)

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